P3.04-038 Pulmonary Resection for Metastatic Pancreaticobiliary Cancer: Can It Be Justified as a Treatment of Choice?: Topic: Miscellaneous II

Abstract

Patients with distant metastases of pancreaticobiliary cancers still have poor prognoses of 3-7% of 5-year survival, and the best reported median overall survival time (MST) of pancreatic carcinoma patients with metastatic stage IV disease treated with optimal chemotherapy was only 11 months. Surgical resection for metastatic lesions from pancreaticobiliary cancer is scarcely performed because of their malignant potential, therefore, few studies have reported on pulmonary metastasectomy for those patients. The purpose of this study is to review our experience of pulmonary resection for metastatic pancreaticobiliary cancer, and to assess whether this treatment offers them better survival. Between 2007 and 2015, 21 patients of pancreaticobiliary cancer had potentially resectable pulmonary metastases after definitive resection of primary site (pancreatic cancer, n=9; cholangiocarcinoma, n= 10; gallbladder cancer, n= 2). There were 14 males and 7 females with a median age of 67 years (42-81years). The medical records were retrospectively reviewed, and the overall survival was analyzed. Disease-free interval (DFI) was defined as the time between operations for the primary cancer and the metastatic lesion. The median DFI was 51 months (4-145 months), and 11 patients had solitary pulmonary lesion, 5 had double lesions, and 6 had three or more. Operative procedures of metastasectomy consisted of 15 wedge resections, 2 segmentectomies, and 4 lobectomies. Although no surgical complications and operative mortalities occurred, 9 patients died of primary diseases after pulmonary resection. The estimated MST after pulmonary resection was 35 months, and 3 and 5-years survival was 32% and 16%, respectively. Overall 3-year survival of patients with longer DFI (DFI> 36months) was marginally significantly better than that of those with shorter DFI (DFI≤36months) (49% vs. 19%, p=0.17). The longest survivor was still alive more than 5 years without recurrence after lung resection. Pulmonary resection for metastatic pancreaticobiliary cancer could be performed safely and might offer better survival. Although the optimal operative indication is still unclear, our results suggest that pulmonary resection could be a treatment of choice in selected patients with those diseases. Longer DFI before pulmonary metastasis might be helpful to select proper patients for the metastasectomy.